The therapeutic landscape of COPD has changed dramatically since I started treating this disease quite some time ago. The medications that are now available to help patients with this chronic progressive disease are light years better than the ones I had 30 years ago. In fact, there are so many products now available that the question is, which is best for which patient. The basic medications we now have for COPD fall into 3 categories. The categories go by abbreviations: ICS, LABA and LAMA. Each one of the category drugs can be given by separate inhaler and some have been combined in one inhaler. Most commonly patients with stage 3 or 4 COPD have been offered all three categories requiring the use of at least two separate and different inhalers. You can imagine that this can cause problems for some patients since the different drugs often are taken on different schedules. If you have COPD and are reading this article you know exactly what I mean. The most recent innovation is the combining of all three categories of drugs into one inhaler. Testing of this new combined approach is underway and I am certain in fairly short order we will have inhalers which contain all three categories which will be used on one single schedule. Of course, several manufacturers will be combining their own specifi c drugs and there will be a marketing blitz telling us that one is better than another. Which insurances will cover these new drugs and their cost is yet to be defined.